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Before breast reconstruction surgery

Planning your surgery

You can start talking about reconstruction as soon as you know you have breast cancer. You’ll want your breast surgeon and your plastic surgeon to work together to come up with the best possible plan for reconstruction.

After reviewing your medical history and overall health, your surgeon will explain which reconstructive options are best for you based on your age, health, body type, lifestyle, and goals. Talk with your surgeon openly about what you expect. Be sure to voice any concerns and priorities you have for the reconstruction, and find a surgeon that you feel comfortable with. Your surgeon should explain the limits, risks, and benefits of each option.

Breast reconstruction after a mastectomy can make you feel better about how you look and renew your self-confidence. But keep in mind that the reconstructed breast will not be a perfect match or substitute for your natural breast. If tissue from your tummy, shoulder, or buttocks will be used, those areas will also look different after surgery. Talk with your surgeon about surgical scars and changes in shape or contour. Ask where they will be, and how they will look and feel after they heal.

If you would like to talk with someone who has had your type of surgery, ask about our Reach To Recovery program. The Reach To Recovery volunteers are trained to support people facing breast cancer, as well as those who have surgery, chemotherapy, radiation therapy, and who are thinking about breast reconstruction. Ask your doctor or nurse to refer you to a volunteer in your area, or call us at 1-800-227-2345.

Your surgeon (or other doctors involved) should also explain the details of your surgery, including:

The drugs (anesthesia) that will be used to make you sleep through the surgery

Where the surgery will be done

What to expect after surgery

The plan for follow-up

Costs

Health insurance policies often cover most or all of the cost of reconstruction after a mastectomy. Check your policy to make sure you are covered, and find out what your co-payment might be (that is, what portion of the bill you’ll be expected to pay out of pocket). Also, see if there are any limits on what types of reconstruction are covered.

Make sure your insurance company will not deny breast reconstruction costs. Your surgeon may be able to help you with this if your insurance plan wants to deny coverage, so be sure to ask. It may take some time and effort, because health plans have denied coverage for certain reconstruction procedures despite federal laws that require coverage in most cases. They often reverse such decisions on appeal. For more information on this and other insurance issues, see our documents called Women’s Health and Cancer Rights Act, and Health Insurance and Financial Assistance for the Patient With Cancer.

Getting ready for surgery

Your breast surgeon and your plastic surgeon should give you clear instructions on how to prepare for surgery. These will probably include:

Help with quitting smoking

Instructions to take or avoid certain vitamins, medicines, and supplements for a period of time before your surgery

Guidelines on eating and drinking before surgery

Plan to have someone drive you home after your surgery or your stay in the hospital. You may also need them to stay and help you out for a few days.

Where your surgery will be done

Breast reconstruction often means having more than one operation. The first stage creates the breast mound. This may be done at the same time as the mastectomy or later on. It’s usually done in a hospital.

Follow-up procedures, such as expanding implants or creating the nipple and areola, may also be done in the hospital or in an outpatient facility. This decision depends on how much surgery is needed and what your surgeon prefers, so you’ll need to ask about this.

What kinds of anesthesia are used?

The first stage of reconstruction is almost always done using general anesthesia.This means you’ll be given drugs to make you sleep and not feel pain during the surgery.

Follow-up procedures may only need local anesthesia. This means that only the area the doctor is working on will be made numb. A drug called a sedative may also be used to make you feel relaxed but awake. You might feel some discomfort.

Possible risks

Almost any woman who must have her breast removed because of cancer can have reconstructive surgery. Certain risks go along with any surgery, and reconstruction may have certain unique problems for some people.

Some risks of reconstruction surgery are:

Bleeding

Fluid build-up in the breast or the donor site, with swelling and pain

Growth of scar tissue

Infection

Tissue death (necrosis) of all or part of the flap, skin, or fat

Problems at the donor site (this can happen right away and later on)

Loss of or changes in nipple and breast sensation

Extreme tiredness (fatigue)

The need for more surgery to fix problems that come up

Changes in the arm on the same side as the reconstructed breast

Problems with the drugs (anesthesia)

Risks of smoking

Using tobacco tightens (constricts) the blood vessels and reduces the supply of nutrients and oxygen to tissues. As with any surgery, smoking can delay healing. This can cause more noticeable scars and a longer recovery time. Sometimes these problems are bad enough that a second operation is needed to fix them. You may be asked to quit smoking a few weeks or months before surgery to reduce these risks.

Risks of infection

Infection can happen with any surgery, usually in the first 2 weeks after surgery. If an implant has been used, it might have to be removed until the infection clears. A new implant can be put in later. If you have a tissue flap, surgery may be needed to clean the wound.

Risks of capsular contracture

The most common problem with breast implants is capsular contracture. This happens when the scar (or capsule) around the implant tightens and starts to squeeze the soft implant. It can make the breast feel very hard. Capsular contracture can be treated. Sometimes surgery can remove the scar tissue, or the implant may be removed or replaced.